An outbreak of enterovirus 71 in metropolitan Sydney: enhanced surveillance and lessons learnt

Enterovirus infections, although commonly asymptomatic, may also be associated with a wide range of clinical diseases including hand, foot and mouth disease (HFMD), herpangina, aseptic meningitis and acute flaccid paralysis.1 Transmission of enteroviruses can occur directly by the faecal–oral route, from contaminated environmental sources, or by respiratory droplet transmission.1

Human enterovirus 71 (EV71) is a major cause of HFMD worldwide and, in the past 15 years, has caused large outbreaks in South-East Asia associated with severe neurological disease and deaths.2 Patients with severe and fatal cases of EV71 infection have usually been diagnosed with meningitis, encephalomyelitis or brainstem encephalitis associated with systemic features such as cardiopulmonary compromise and myocarditis.3,4 Large outbreaks of EV71 infection have been reported in Victoria (1986), Perth (1999) and Sydney (2000–2001), and all outbreaks included cases of patients with severe neurological disease.5–7 Enterovirus infections (apart from poliomyelitis) are not notifiable in New South Wales.